Editorial

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Welcome to the first homepage edition of i2P for 2012.
In many ways it has been a slow start to the New Year because of having to deal with the “leftovers” from 2011.
One of those items for i2P was that a third-party provider to the site did not advise of a code change to the security section in our subscribe panel, creating a range of frustrated subscribers not able to get on board.
We apologise to all those potential subscribers who were unable to register with us in the second half of 2011, but if you try once more you should have no problem.

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Volume 2012 Number 1

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Servants to the world.

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	Ken Stafford articles by this author...
A Consultant Pharmacist Perspective

Recently I received a number of calls from a concerned relative of one of our veteran clients currently in an aged care facility.
The problems I am hearing about relate to the difficulty in getting the patient’s doctor to write prescriptions for necessary medications, echoing many of the stories I heard during my pharmacy visits about the problem of “owing scripts” and just how hard it is for pharmacists to get them written. If we break down the problem we get this sequence of events:

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1. The residential aged care (RAC) facility patient has medications administered under instructions written in the medication chart.

2. The patient runs out of medication and has no further prescriptions/repeats on hand.

3. The facility staff order the drug from their contracted pharmacist who will usually dispense as an “owing script” ie dispensed under the understanding that the doctor will write a new prescription as soon as possible (the process is really only legal if this script is supplied within seven days.)

4. The doctor may write the script immediately or, as is more common, will take his own sweet time about it.

5. The pharmacist attempts again (and again, and again) to get the script until finally, often many weeks later, it arrives. Meanwhile the pharmacist is usually out of pocket as he cannot claim reimbursement from the PBS and is, strictly speaking, in breach of the regulations and law.

Sounds familiar doesn’t it?
You might wonder why any pharmacist is willing to put up with this stress or if any other professional group would do likewise.
My feeling is that this process is probably highlighting that pharmacists are everybody’s servant.
It appears nursing home staff seem quite happy to let pharmacists do their “dirty work” in relation to the patient’s medical care - provided they have the medicines they are happy and it doesn’t matter that they are expecting pharmacists to break the law. I have yet to hear of any nursing home demanding that a GP actually looks after their patients – much too hard and “we don’t want to upset the doctor”.
In the case that I mentioned earlier, when the caller tried to “encourage” the doctor to do the right thing by their relative the doctor threatened to stop looking after the patient’s medical care!
The nursing home staff wouldn’t help because this was the only doctor willing to look after their patients.
The pharmacist did everything he could for the patient even to the extent of losing the patient co-payment when Safety Net scripts supplied as owing in December were not written until well into the new year.

These stories remind me of my early days in BC (before computers) pharmacy when a doctor was supposed to write the patient’s pension number on the script, but usually didn’t.
Every pharmacy I worked in back then had a series of different coloured biros (to match those of the doctor) and most pharmacists became fairly proficient “forgers”, simply to meet the requirements of a legal script. I never heard of any government agency hounding doctors to have them “do the right thing”.
We can’t upset the medical profession.

The same problem occurs with Medicare Numbers on prescriptions – if the card number is incorrect or the card out of date it is the pharmacist that suffers, not the prescriber. ‘Why?”, I asked Medicare “because only the pharmacist is claiming payment for that script so it is up to him/her to ensure accurate information”.
Everybody’s servant???
I bet the doctor gets paid.

This requirement for pharmacists to make sure that all the clerical aspects of a PBS script are correct has always irritated me, as has the expectation by patients and nursing home staff that pharmacy will supply a medication under the owing script provisions to ensure continuity of care.
Why has continuity of care always been the (apparent) sole responsibility of the pharmacist in this rather than the prescribing doctor or nursing staff?
It seems that pharmacists the low men on the totem pole, acting like a doormat and allowing all others to walk over them.

In previous times I watched in frustration as pharmacy took the brunt of these problems with no real solution in sight.
Now there may be a way out of it– permit pharmacists to write PBS scripts with the same conditions as nurse practitioners and some other allied health professions.
I don’t advocate open slather, merely a process whereby pharmacists servicing nursing homes can, with the authorisation of the GP, write scripts based on the medication chart to cover supply of medicines. The same procedure could be applied to private hospitals and discharge scripts from public hospitals.
I am not advocating pharmacists become surrogate doctors, I’m simply suggesting that a fairly simple clerical process (writing a continuing treatment script) might become the province of selected pharmacists.
This could be restricted to specialists such as accredited consultant pharmacists.
Possibly not the complete answer to the owing script problem in nursing homes but this would go a long way to solving it.
I’m sure many of our colleagues will argue against this idea, giving a multitude of reasons why it wouldn’t work, but just imagine how great it would feel to be, even in so small a manner, masters of our own destiny and no longer servants to the world?

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